Provider Demographics
NPI:1598262776
Name:HOLLEH TAJALLI DDS LLC
Entity Type:Organization
Organization Name:HOLLEH TAJALLI DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:HOLLEH
Authorized Official - Middle Name:
Authorized Official - Last Name:TAJALLI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:410-707-3704
Mailing Address - Street 1:1633 COVINGTON ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21230-4711
Mailing Address - Country:US
Mailing Address - Phone:410-707-3704
Mailing Address - Fax:
Practice Address - Street 1:1030 S LINWOOD AVE UNIT 200
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-5091
Practice Address - Country:US
Practice Address - Phone:410-707-3704
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-12
Last Update Date:2019-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15974261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental